RESULT OF SURGERY FOR ESOPHAGEAL CANCER - ANALYSIS OF A SERIES OF 349CASES ACCORDING TO THE TYPE OF RESECTION

Despite obvious improvements in operative and postoperative management after esophageal resection, surgical treatment of esophageal cancer i s still disappointing in terms of long term results. The purpose of th e present study was to verify these poor results satistically and to d iscuss the value of a modified therapeutic approach. Our experience co vers 349 esopphageal resections performed between 1979 and 1992. These patients were predominantly males (93 %) with squamous cell carcinoma (86 %). The majority of the patients underwent either an Ivor-Lewis ( 52 %) or an Akiyama procedure (36 %). Survival was estimated according to the Kaplan-Meier model. Influence of parameters such as sex, histo logy, type of resection and TNM-staging was assessed with the << logra nk >> test. The perioperative mortality was 10%. The non-fatal morbidi ty rate was 34%, and was most often related to anastomotic leaks. Path ological staging disclosed a majority of T3 tumors (71 %). The overall survival rate was 54 % at one year, 28 % at 2 years and 9 % at 5 year s. This survival was not influenced by either histology (squamous cell or adenocarcinoma), the type of resection (Ivor-Lewis or Akiyama proc edure). A slightly superior survival rate was observed after Ivor-Lewi s procedure and is explained by a lower postoperative complication rat e. In particular, diffuse N2 disease (abdominal and mediastinal) had a worse prognosis than localized N2. N1 disease was probably understage d, since survival was comparable to localized N2. The natural history was characterized by development of metastases (43 %) rather than by l ocal recurrence. We conclude that these results may justifiy surgery f or palliation of dysphagia in so far as the post-operative morbidity i s reduced, as we observed with Ivor-Lewis procedures. However, improve ment of long-term survival requires a multimodality oncologic approach .